{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WILLIAM   J HODGES","gend":0,"add":"109 SLASH DRIVE                                             ","city":"ASHLAND                       ","state":"VA","zip":"23005-2176","dob":"1983-07-25","age":"","mstatus":"","insh":10199218,"cliId":"","pno":8046173598,"cno":8046173598,"email":"","ename":"","eno":"","pphy":"YOUNG, CHRISTINE M                                          ","ppno":"","pcpadd":"306 ASHCAKE RD,Ste 117","pcpcity":"ASHLAND                       ","pcpstate":"VA","pcpzip":230052323,"pcpcounty":"","pcpid":"P0149257","pcpname":"BON SECOURS INTERNAL MEDICINE OF ASHLAND","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"109   SLASH DRIVE                                           ","madd2":"                                                            ","madd3":"","mcity":"ASHLAND                       ","mstate":"VA","mzip":"23005-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J06.9","R05","H92.03","R09.81","J32.9","J98.01","I25.10","J34.89","E78.5","F17.200","Z79.82","R50.9","B02.9","M25.50","L72.3","M25.552","S76.019A","W18.49XA","S76.012A"],"date":["2019-10-16","2019-10-16","2019-10-16","2019-10-16","2019-10-16","2019-10-16","2021-10-21","2019-10-16","2021-10-21","2021-10-21","2021-10-21","2019-10-16","2020-08-31","2020-08-31","2021-03-16","2021-10-21","2021-10-21","2021-10-21","2021-10-21"],"priorHcc":["","","","","","","","","","","","","","","","","","",null]}},{"a":[]}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","65862044930","VALACYCLOVIR","1GM","21","Select","Select",""],["","68682010301","DICLOFENAC ","TAB 100MG ER","30","Select","Select",""],["","65862044930","VALACYCLOVIR ","TAB 1GM","21","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":""}]}]}